Genitourinary Syndrome of Menopause

“Genitourinary syndrome of menopause is caused by
a decrease in estrogen production. Less estrogen
makes your vaginal tissues thinner, drier, less elastic…”.1

Umbrella

What may the Genitourinary Syndrome of Menopause Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Atrophic Vaginitis
  • Genital Atrophy
  • Genitourinary/Genito-Urinary Syndrome of Menopause (GSM)
  • Menopause Vaginal Dryness
  • Urogenital Problems
  • Vaginal Atrophy
  • Vaginal Dryness
  • Vaginal Symptoms
  • Vulvovaginal Atrophy (VVA)

Definition

What is the genitourinary syndrome of menopause (GSM)?

DotS the definition of GSM may vary. On page one in Vaginal Dryness the North American Menopause Society (NAMS) (now The Menopause Society (TMS)) elaborate on:

“The genitourinary syndrome of menopause (GSM) includes bothersome vaginal, vulvar (lips of the vagina), and urinary symptoms that can affect quality of life, sexual satisfaction, and even your relationship with your partner”.2

In Mayo Clinic Q and A: Treatment for Vaginal Dryness for Menopausal Women the (United States) Mayo Clinic elaborate on:

“Vaginal dryness is common in women who are approaching menopause and those who have gone through menopause. Other related symptoms include vaginal and vulvar irritation; burning or itching; discomfort or pain with sexual activity; and urinary symptoms, such as more frequent or urgent urination, urge leak, and urinary tract infections. Together, these symptoms are referred to as “genitourinary syndrome of menopause,” or GSM. These symptoms occur in roughly half of menopausal women and are even more common in women with breast cancer”.3

Common or Not

How common is GSM in postmenopausal women?

In Symptoms of Menopause: Bladder, Vaginal and Vulval Problems the (Australian) Jean Hailes for Women’s Health (JH) explain:

“As you move into perimenopause and menopause, low oestrogen levels change your vulval, vaginal and bladder tissues. These changes may affect up to half of postmenopausal women”.4

Symptoms

What may be symptoms of GSM?

In Vaginal Atrophy: Symptoms & Causes – Symptoms the Mayo Clinic explain:

“Genitourinary syndrome of menopause (GSM) signs and symptoms may include:

  • Vaginal dryness
  • Vaginal burning
  • Vaginal discharge
  • Genital itching
  • Burning with urination
  • Urgency with urination
  • Frequent urination
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Light bleeding after intercourse
  • Discomfort with intercourse
  • Decreased vaginal lubrication during sexual activity
  • Shortening and tightening of the vaginal canal”.5

Cause

What causes GSM?

In Vaginal Atrophy: Symptoms & Causes – Causes the Mayo Clinic elaborate on:

“Genitourinary syndrome of menopause is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile”.6

Common or Not

How common is GSM?

In Genitourinary Syndrome of Menopause: Key Points the Australasian Menopause Society note:

  • “These symptoms are common- affecting between 40% and 90% of menopausal women. Urinary incontinence develops in up to 50% of postmenopausal women”.7

Treatment

What are some GSM treatments?

On page one and two in Vaginal Dryness: Treatment Options NAMS elaborate on:

Genitourinary Syndrome of Menopause“There are many effective treatment options for GSM, including over-the-counter and prescription therapies. First-line therapies for less severe symptoms include nonhormone over-the-counter lubricants used as needed for sexual activity and moisturizers used regularly (several times per week) to maintain moisture. Prescription therapies include low-dose vaginal estrogens, vaginal dehydroepiandrosterone inserts, and oral ospemifene. Nonhormone lubricants and moisturizers can be combined for optimal symptom relief and can be used in combination with prescription therapies for more severe symptoms.

  • “Nonhormone Remedies
    • Vaginal Lubricants…
    • Vaginal Moisturizers…
    • Regular Sexual Stimulation…
    • Expanding Your Views of Sexual Pleasure…
    • Vaginal Dilators…
    • Pelvic Floor Exercises…
  • Vaginal Hormone Therapy…
    • An effective and safe treatment, low-dose local estrogen applied directly to the vagina…
    • FDA-approved low-dose vaginal estrogen products…
    • Dehydroepiandrosterone (DHEA; Prasterone)
    • Low-dose vaginal estrogen or DHEA may be options for women with a history breast or uterine cancer…
  • Systemic Estrogen Therapy
  • Other Therapies…
    • Ospemifene
    • Vaginal Laser Therapy…”.8

Painful Intercourse

How may painful intercourse be resolved?

The Mayo Clinic explain:

“… make an appointment to see your doctor if you experience painful intercourse that’s not resolved by using a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) or water-based lubricant (Astroglide, K-Y Jelly, Sliquid, others)”.9

Vaginal Estrogen

How may vaginal estrogen be used?

In The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract published July 2022, the NAMS note:

“For bothersome genitourinary syndrome of menopause symptoms not relieved with over-the-counter therapies in women without indications for use of systemic hormone therapy, low-dose vaginal estrogen therapy or other therapies (eg, vaginal dehydroepiandrosterone or oral ospemifene) are recommended”.10

Can estrogen be placed directly into the vagina?

On page one in Deciding About Hormone Therapy Use, published July 2022, the NAMS explain:

“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina. (The MenoNote “Vaginal Dryness” covers this topic in detail)”.11

On page three in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published online 10 June 2022, one of the recommendations is:

  • “Low-dose and ultra-low dose vaginal oestrogen preparations can be taken by perimenopausal and menopausal women experiencing genitourinary symptoms and continued for as long as required. All vaginal oestrogen preparations have been shown to be effective in this context and there is no requirement to combine vaginal oestrogens with systemic progestogen treatment for endometrial protection, as low-dose and ultra-low dose vaginal oestrogen preparations do not result in significant systemic absorption or endometrial hyperplasia”.12

Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025)

What is the Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025), published April 2025, endorsed by The International Society for the Study of Women’s Sexual Health (ISSWSH) and The Menopause Society (TMS)?

In Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025) the authors elaborate on:

“This guideline provides information to clinicians regarding identification, diagnosis, counseling, and treatment for patients with GSM to optimize symptom control and quality of life while minimizing adverse events. The strategies defined in this document were derived from evidence-based and consensus-based processes; however, shared decision-making is the optimal strategy to individualize level of impact and ultimate interventions”.13

What is AUA, SUFU and AUGS?

In the context above, these abbreviations stand for the:

Health Care Provider

What if I think I have GSM?

In The 2023 Practitioner’s Toolkit for Managing Menopause – Effectiveness: Local Treatment of Urogenital Atrophy, published online 01 December 2023, the authors note:

“Urogenital symptoms due to estrogen insufficiency are under-recognized and under-treated. These symptoms can be effectively treated with an array of local therapies including intravaginal estrogen preparations or DHEA (prasterone) and intravaginal moisturizers. Concurrent progestogen therapy is not required. Many women require local therapy, in addition to systemic MHT, to relieve urogenital symptoms. It is important patients understand that treatment needs to be ongoing and is not simply a short course of therapy”.14

In Symptoms of Menopause: Bladder, Vaginal and Vulval Problems – Urinary Symptoms the JH explain:

“While symptoms such as hot flushes usually disappear over time, bladder, vaginal and vulval problems can persist and may even get worse. But many treatments are available, so ask your doctor for recommendations”.15

On page two in Vaginal Dryness the NAMS also note:

“Note: Vaginal and vulvar symptoms not related to menopause include yeast infections, allergic reactions, and certain skin conditions, so consult your healthcare professional if symptoms do not improve with treatment”.16

Health Topics A-Z

Where may I find Health Topics A-Z related to Genitourinary Syndrome of Menopause?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

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Links

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New or Updated

  1. ACOG Explains: Managing Menopause Symptoms [American College of Obstetricians and Gynecologists]
  2. Askearlymenopause.org [+ Video: What Is Early Menopause?]
  3. BMS TV: Urogenital Atrophy
  4. Bioidentical Hormones: Are They Safer?
  5. Bladder Control: Lifestyle Strategies Ease Problems
  6. Bladder and Lower Urinary Tract Issues Often Overlooked During Menopause Transition
  7. CAMS Menopause Hour: Genitourinary Wellness In Women [Council of Affiliated Menopause Societies]
  8. Complementary and Alternative Therapies for Genitourinary Syndrome of Menopause: An Evidence Map
  9. Consumer Video and Podcast Series: 2024 Consumer Videos and Podcasts – Preparing for Your Menopause Health Care Visit
  10. Deciding About Hormone Therapy Use
  11. Do Home Remedies Work for UTIs?
  12. Douching
  13. Dr. Stephanie Faubion – Genitourinary  Syndrome of Menopause
  14. Estradiol (Vaginal Route)
  15. Experiencing Vaginal Dryness? Here’s What You Need To Know
  16. Experts Answer Your Menopause Questions In New Video
  17. Find A Menopause Practitioner [United States and Other]
  18. Find An AMS Member [Australasian Menopause Society i.e. Australia and New Zealand]
  19. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  20. Gaslighting of Genitourinary Symptoms of the Menopause
  21. Genitourinary Syndrome of Menopause
  22. Genitourinary Syndrome of Menopause [Video]
  23. Genitourinary Syndrome of Menopause [Podcast]
  24. Genitourinary Syndrome of Menopause and the False Promise of Vaginal Laser Therapy
  25. Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025) [April 2025]
  26. Genitourinary Syndrome of Menopause: A Systematic Review on Prevalence and Treatment [Video]
  27. Genitourinary Syndrome of Menopause: New Name, Old Problem
  28. HRT Questions Answered
  29. Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review
  30. Hormone Therapy: Is It Right for You?
  31. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Common Questions About Vaginal Oestrogen
  32. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – How and When To Use Vaginal Oestrogen
  33. How To Talk To Your Doctor About Bladder Leakage
    Menopause Symptoms
  34. How To Talk To Your Doctor About Menopause
  35. How To Talk To Your Doctor About Painful Sex
  36. International Society for the Study of Women’s Sexual Health: Find A Provider
  37. Is It Too Late To Start HRT?
  38. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause
  39. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Sexual Wellbeing, Intimacy and Menopause [+ Video: Menopause Is the End of Your Sex Life]
  40. Low Estrogen Bladder Symptoms and Treatment
  41. Lubricant Alternatives: What To Use and What To Avoid
  42. Managing Menopause Symptoms [+ Video Courtesy: Mayo Clinic News Network]
  43. Mayo Clinic Minute: Menopause and Sexual Health [+ Video Courtesy: Mayo Clinic News Network]
  44. Mayo Clinic Q and A: 6 UTI Myths and Facts
  45. Mayo Clinic Q and A: Perimenopause Transitions and Concerns
  46. Genitourinary Syndrome of MenopauseMenopause
  47. Menopause
  48. Menopause Checklist Podcast: Episode 1: A Wee Problem
  49. Menopause Checklist Podcast: Episode 6: Hello Lubricant!
  50. Menopause Management Options
  51. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
    Genitourinary Syndrome of Menopause
  52. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Symptom Tracker
    Genitourinary Syndrome of Menopause
  53. Menopause Patient Information [Videos] 2. Talking To Your GP About Menopause
  54. Menopause Preparedness Toolkit Video Series: Common Conditions Associated With Menopause and Midlife
  55. Menopause Ruining Your Sex Life?
  56. Menopause: Identification and Management [NICE Guideline Published: 12 November 2015 Last Updated: 07 November 2024]
    Genitourinary Syndrome of Menopause
  57. Menopause: Identification and Management: NICE Guideline [NG23] Published: 12 November 2015 Last Updated: 07 November 2024
  58. Menopause: Understanding the Changes and Finding Relief | Dr Susan Davis | The Proof Podcast EP 256
  59. Navigating Menopause Together: How Partners Can Help
  60. Navigating Menopause: Expert Insights and Solutions | Dr Susan Davis | The Proof Podcast EP 245
  61. Navigating Menopause: Honest Answers To All Your Questions [+ Video: What To Expect in Menopause]
  62. Painful Vaginal Sex (Dyspareunia)
  63. Pelvic Floor Health | Dr Louise Newson LIVE
  64. Perimenopause
    Genitourinary Syndrome of Menopause
  65. Perimenopause and Menopause Symptom Checklist
    Genitourinary Syndrome of Menopause
  66. Questions To Ask Your GP About Menopause
  67. Surprising Menopause Symptoms Q&A | Dr Louise Newson
  68. Symptoms of Menopause: Bladder, Vaginal and Vulval Problems
  69. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society
  70. The 2023 Practitioner’s Toolkit for Managing Menopause
  71. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data
  72. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause
  73. Therapeutic Choices for Genitourinary Syndrome of Menopause (GSM) In Breast Cancer Survivors: A Systematic Review and Update
  74. The Truth About Menopause Supplements | Dr Sarah Berry
  75. Treating Genitourinary Syndrome of Menopause In Breast Cancer Survivors
  76. Treating Incontinence During Your Perimenopause and Menopause Years
  77. UTI: This Common Infection Can Be Serious
  78. Urogenital Problems
  79. Urologic View In the Management of Genitourinary Syndrome of Menopause
  80. Using Natural Therapies In the Menopause Transition – Webinar
  81. Vaginal Atrophy
  82. Vaginal Atrophy
  83. Vaginal Dryness
  84. Vaginal Dryness
  85. Vaginal Dryness
  86. Vaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it?
  87. Vaginal Dryness: Alternative Treatments
  88. Video & Podcast Library: Videos – World Menopause Day 2024: Menopause and Hormone Therapy: Current Perspectives and Controversies
  89. Videos & Podcasts: Videos – Genitourinary Syndrome of Menopause
  90. Videos & Podcasts: Videos – Menopause and Hormone Therapy: Current Perspectives and Controversies
  91. Videos & Podcasts: Videos – Vulvar Diseases, Overview for Aging Women
  92. Webinars: Previous – The Burn, the Itch, the Pain, the Urge: GSM In Women
  93. What Is the Difference Between Vagifem and Estring?
  94. What Types of Vaginal Oestrogens Are There?
  95. When Does Perimenopause Start and How Do You Define the Beginning
  96. Which Vaginal Moisturiser Should You Use?
  97. World Menopause Day 2024: Leaflet for Women – Menopause and Menopause Hormone Therapy [Multiply Languages]
  98. World Menopause Day 2024: Poster for Women – The 5 Ws of Menopause Hormone Therapy (MHT)
  99. Vulval Irritation
  100. Vulvovaginal Atrophy

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Vaginal Atrophy: Symptoms & Causes – Causes. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 30 April 2025
  2. Vaginal Dryness. 2022: 1. Menopause Society https://menopause.org/wp-content/uploads/for-women/mn-vaginal-dryness_4e454569-8d3c-4346-a00b-515f46b378c9.pdf Accessed: 30 April 2025
  3. Mayo Clinic Q and A: Treatment for Vaginal Dryness for Menopausal Women. 14 July 2021. Mayo Clinic https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-treatment-for-vaginal-dryness-for-menopausal-women/ Accessed: 30 April 2025
  4. Symptoms of Menopause: Bladder, Vaginal and Vulval Problems. Last Updated: 23 April 2025. Last Reviewed: 23 April 2025. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-symptoms/ Accessed: 30 April 2025
  5. Vaginal Atrophy: Symptoms & Causes – Symptoms. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 30 April 2025
  6. Vaginal Atrophy: Symptoms & Causes – Causes. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 30 April 2025
  7. Genitourinary Syndrome of Menopause: Key Points. Content Created October 2024. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/genitourinary-syndrome-of-menopause
  8. Vaginal Dryness: Treatment Options. 2022: 1-2. Menopause Society https://menopause.org/wp-content/uploads/for-women/mn-vaginal-dryness_4e454569-8d3c-4346-a00b-515f46b378c9.pdf Accessed: 30 April 2025
  9. Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 30 April 2025
  10. The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract. Published July 2022. Menopause Society https://journals.lww.com/menopausejournal/Abstract/2022/07000/The_2022_hormone_therapy_position_statement_of_The.4.aspx Accessed: 30 April 2025
  11. Deciding About Hormone Therapy Use. Published July 2022. Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 30 April 2025
  12. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayesena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published Online 10 June 2022 https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 30 April 2025
  13. Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025). April 2025. American Urological Association
    https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause Accessed: 30 April 2025
  14. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam12 September 2024, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: The 2023 Practitioner’s Toolkit for Managing the Menopause Supporting Notes – Effectiveness: Local Treatment of Urogenital Atrophy. Published Online: 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 30 April 2025
  15. Symptoms of Menopause: Bladder, Vaginal and Vulval Problems – Urinary Symptoms. Last Updated: 23 April 2025. Last Reviewed: 23 April 2025. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-symptoms/ Accessed: 30 April 2025
  16. Vaginal Dryness: Note. 2022: 2. Menopause Society https://menopause.org/wp-content/uploads/for-women/mn-vaginal-dryness_4e454569-8d3c-4346-a00b-515f46b378c9.pdf Accessed: 30 April 2025
Topic Last Updated: 30 April 2025 – Topic Last Reviewed: 30 April 2025

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